Is Tranexamic Acid Associated With a Reduced Need for Hypotensive Anesthesia During Orthognathic Surgery?

Area of Science:

• Oral and Maxillofacial Surgery
• Anesthesiology
• Surgical Hemostasis

Background:

• Hypotensive anesthesia (HA) is used in orthognathic surgery to reduce blood loss, but carries risks of hypoperfusion.
• Tranexamic acid (TXA) is known to reduce bleeding, but its isolated effect without HA in orthognathic surgery is not well-studied.
• Evaluating TXA without HA could reveal its efficacy in making HA an unnecessary risk.

Purpose of the Study:

• To assess surgical site visualization during bimaxillary orthognathic surgery.
• To measure blood loss in patients receiving TXA without deliberate HA.
• To determine if TXA alone is sufficient for managing blood loss in this surgical context.

Main Methods:

• Prospective cohort study of 115 patients (ages 14-75) undergoing bimaxillary orthognathic surgery with TXA.
• Patients were divided into two groups based on the percentage of time under hypotensive anesthesia (<10% vs. >10%).
• Blood loss was evaluated using surgical field visibility, estimated blood loss, and changes in hemoglobin and hematocrit levels.

Main Results:

• No statistically significant differences were found between the groups regarding surgical field visibility.
• Estimated blood loss, hemoglobin, and hematocrit changes showed no significant differences between low (<10%) and high (>10%) hypotensive anesthesia exposure.
• P-values for all main outcome variables were greater than 0.1, indicating no statistically significant association.

Conclusions:

• Tranexamic acid (TXA) effectively maintains surgical visibility and controls blood loss during bimaxillary orthognathic surgery under normotensive conditions.
• The use of normotensive anesthesia with TXA may offer cost savings and increased efficiency compared to HA.
• These findings suggest a potential to decrease reliance on HA, but a randomized controlled trial is needed for confirmation.